More Evidence Weight-Loss Surgery Helps People With Diabetes

MONDAY March 31, 2014, 2014 -- Weight-loss surgery might do more than help people shed pounds. For some who have the surgery, it may also put type 2 diabetes into remission for several years, a new study suggests.

The success rate in controlling diabetes depended on the type of weight-loss surgery, the researchers said.

Patients who had the more involved gastric-bypass surgery were more likely to achieve control of their type 2 diabetes without the use of medications, compared to those who had a procedure known as sleeve gastrectomy, according to the new research.

"This study is a three-year follow-up. Initially, we showed that people lost a lot of weight after surgery, and for some people, that caused their type 2 diabetes to come to an end," said study co-author Dr. Sangeeta Kashyap, an endocrinologist at the Cleveland Clinic's Endocrinology & Metabolism Institute. "But no one knew how lasting that would be."

"One-third [of patients] in the gastric bypass group had remission of diabetes -- meaning they had normal blood sugar control -- and a quarter of the people in the sleeve gastrectomy group had remission of type 2 diabetes," Kashyap said. "These effects are real, and they're persistent for at least three years. Essentially, these patients have had a vacation from diabetes for three years."

Even when people weren't able to achieve a full remission from type 2 diabetes, weight-loss surgeries still helped many participants take less medication to control their blood sugar, according to the study.

Kashyap also said quality of life was improved for people who had the weight-loss surgery compared to those who received standard type 2 diabetes management. Quality-of-life measures included bodily pain, physical functioning, energy levels and emotional well-being.

Results of the study will be presented Monday at the American College of Cardiology annual meeting in Washington, D.C., and published in the March 31 issue of the New England Journal of Medicine.

Type 2 diabetes causes the body to use the hormone insulin inefficiently. Insulin helps get sugar from the blood into the body's cells to be used as fuel. When cells become insulin resistant, that fuel can't make it into the cells and instead builds up in the blood. High levels of sugar in the blood over long periods of time can cause serious complications, such as kidney and heart disease, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Although the exact cause of type 2 diabetes remains unknown, one of the biggest risk factors for developing the disease is obesity.

The current study included 150 people with type 2 diabetes. Their average age was 49, and two-thirds were female. At the start of the study, the patients' average body-mass index (BMI) -- a rough estimate of a person's body fat -- was nearly 37. Below 25 is considered normal weight and over 30 is considered obese, according to the U.S. Centers for Disease Control and Prevention.

One-third of the study volunteers were randomly selected to receive standard medical management of their type 2 diabetes, while another third was given gastric-bypass surgery and medical management. The final third received sleeve gastrectomy plus medical management of their diabetes.

Gastric-bypass surgery routes food directly to the small intestine, which means it bypasses the stomach, duodenum and large intestines, according to the NIDDK. Sleeve gastrectomy reduces the size of the stomach.

Kashyap said the biggest benefits of the surgeries likely stem from the amount of weight lost. "When you're taking drugs to manage diabetes, it's hard to lose significant amounts of weight," she said. "A lot of diabetes medications make weight loss hard."

Weight-loss surgery costs about $25,000 to $30,000, Kashyap said, and requires about two to four weeks time off of work. Insurance companies generally pay for the procedure only for people who have a BMI over 35, she said.

Because experts at the Cleveland Clinic believe weight-loss surgery can be beneficial for people with lower BMIs who also have other health problems, such as type 2 diabetes, their insurance program pays for the procedure in people with BMIs as low as 30, Kashyap said.

Although weight-loss surgery can help some people, however, it might create new problems, according to an expert not involved in the study.

"This study reassures that these procedures work, and may be worth trying in some patients," said Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center, in New York City. "But they're not ... a cure. You're changing one disease (type 2 diabetes) for another (malabsorption)."

Malabsorption -- nutrients being poorly absorbed in the body -- can be a later effect of weight-loss surgery, according to the NIDDK.

Still, Zonszein said, in people who don't respond well to type 2 diabetes medications or who don't tolerate them well, "they may do much better with surgery. We really have to look at each patient independently."

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